Download the ESMO 2012 Abstract Book - Oxford Journals

Annals of Oncology
1584P HOME-BASED ZOLEDRONIC ACID (ZOL) INFUSION
THERAPY IN PATIENTS WITH SOLID TUMOURS:
COMPLIANCE AND PATIENT-NURSE SATISFACTION
T. Lebret 1 , J. Mouysset 2 , A. Lortholary 3 , C. El Kouri 3 , L. Bastit 4 , M. Ktiouet 5 ,
K. Slimane 5 , X. Muracciole 6 and S. Guérif 7
1 Urology, Hôpital Foch, Suresnes, FRANCE, 2 Oncology, Polyclinique Parc
Rambot-Provençale, Aix en Provence, FRANCE, 3 Medical Oncology, Catherine
de Sienne Institute, Nantes, FRANCE, 4 Radiothérapie, Centre de Radiothérapie,
Evreux, FRANCE, 5 Oncology, Novartis Pharmaceuticals, Rueil-Malmaison,
FRANCE, 6 Service de Radiotherapie, CHU La Timone APHM Marseille, Marseille,
FRANCE, 7 Radiothérapie, CHU Poitiers, Poitiers, FRANCE
Objective: To explore patient and nurse satisfaction, compliance with practice
guidelines, technical feasibility, and safety of home infusion of the bisphosphonate
ZOL.
Methods: This was a prospective longitudinal 1-year survey of home ZOL therapy in
patients with bone metastases secondary to a solid malignancy. Randomly selected
physicians prescribed home ZOL therapy (4 mg Zometa®, 15-min IV infusion, every
3-4 weeks). Three questionnaires were administered at 3 time points: physician
questionnaire, nurse satisfaction and feasibility questionnaire, and patient satisfaction
questionnaire. The main end-points were patient and nurse satisfaction with home
ZOL therapy.
Results: Of the 154 physicians who agreed to participate, 87 (56.5%) enrolled 818
patients for whom 788 case report forms were received of which 763 met inclusion
criteria. Overall, 343 nurses (97.5% community) took part. Patient characteristics
were: median age 68 yrs (30-95); male-female ratio 40/60; primary cancer: breast
55.2%, prostate 28.4%, lung 7.2%, other 9.4%; ECOG-PS 0 or 1: 78.6%. Overall,
90.9% of nurses were either highly satisfied or satisfied with how home ZOL therapy
was run; 96.7% found the infusion either very easy or easy to perform; 97.5% felt that
home therapy promoted a good relationship with patients, and 73% were either
highly satisfied or satisfied with their hospital contacts. Among patients, 95.3% were
either very satisfied or satisfied with home ZOL therapy. Causes for satisfaction were
quality of the nurse-patient relationship (57.6%) in addition to expected reasons (e.g.
less time travelling/waiting (68.8%), less disruption to daily routine (36.6%)). ZOL
therapy was well tolerated (discontinuation due to adverse events 6.1%; osteonecrosis
of the jaw 0.6%, fractures 0.2%). Practitioner compliance with recommendations was
73% for dental hygiene checks at inclusion and 48-56% thereafter, 66% for
pre-infusion patient hydration, and often undocumented for calcium/vitamin D
supplementation.
Conclusions: There was a very high level of both patient and nurse satisfaction with
home ZOL therapy. However, improved compliance with practice guidelines should
be encouraged.
Disclosure: T. Lebret: Consulting fees : Amgen, Novartis Advisory board : Amgen,
Novartis Honorarium study Novartis, J. Mouysset: Honorarium study Novartis, A.
Lortholary: Honorarium study Novartis, C. El Kouri: Honorarium study Novartis, L.
Bastit: Honorarium study NovartisM. Ktiouet: Novartis EmployeeK. Slimane:
Novartis Employee, X. Muracciole: Advisory board Novartis Consulting fees
Novartis, S. Guérif: Consulting fees Novartis.
1585P A PROSPECTIVE MONO-INSTITUTIONAL STUDY ON THE
IMPACT OF A SYSTEMATIC PREVENTION PROGRAM ON
THE INCIDENCE AND OUTCOME OF OSTEONECROSIS OF
THE JAW (ONJ) IN PATIENTS (PTS) TREATED WITH
BISPHOSPHONATES (B) FOR BONE METASTASES
N.M. La Verde, A. Bramati, S. Piva, M.C. Dazzani, S. Girelli, A. Moretti, D. Mihali,
M. Dimaiuta, A. Pinto and G. Farina
Oncology, A.O. Fatebenefratelli e Oftalmico, Milan, ITALY
Background: B are commonly used to treat bone metastases in cancer pts, who have
a higher risk of developing ONJ. The elective involvement of the jaw can have an
anatomic rationale, since this region has a thin mucosa and microbiological
contamination. The jaw is exposed to dental microtraumatisms and infections, so
reparation mechanisms are essential. B inhibits bone turnover and since the
increased demand for bone repair isn’t satisfied, the bone is exposed to osteonecrosis.
To reduce this risk we have developed a specific prevention program focused
primarily on reducing its incidence and, wherever it develops, the need for
demolitive surgery with permanent sequelae.
Patients and methods: All consecutive pts with bone lesions, that were eligible for
treatment with B (either zoledronic or pamidronic acid) were prospectively evaluated.
Before starting B, each patient was referred to an specialized odontoiatric team that
performed: 1. dental examination; 2. orthopantomography; 3. professional dental
hygiene. If the oral conditions weren’t satisfactory (i.e., tooth decay, dental plaque,
broken teeth), the dentist completed the necessary intervention before starting B.
Results: From April 2007 to April 2012 we collected data of 254 pts, 243 of which
were treated with zoledronic acid and 9 with pamidronic acid. The median age was
74 years old (range 37-95), 92 male and 162 female. All pts had bone involvement:
74 pts had breast cancer, 39 lung cancer, 36 prostate cancer, 33 multiple myeloma
and 72 others. On average the pts received 9.7 cycles (range 1-48). No case of ONJ
was recorded.
Conclusions: Our study demonstrates that ONJ can be effectively prevented with a
serious program that involves a multidisciplinary team. The odontoiatric basal
evaluation is necessary to identify pts with oral pathologies or inadequate oral
hygiene who must undergo preventive dental treatment. When reparative
phaenomena are compromised by B, the healthy oral environment prevents
infections and subsequent morbidity. In our opinion, this type of preventive program
should be mandatory for all pts starting B.
Disclosure: All authors have declared no conflicts of interest.
1586P QOL AND SURVIVAL SURVEY OF CANCER CACHEXIA IN
ADVANCED NSCLC PATIENTS - JNUQ-LC STUDY, TORG0912
S. Atagi 1 , F. Imamura 2 , A. Yokoyama 3 , K. Minato 4 , T. Harada 5 , N. Katakami 6 ,
T. Yokoyama 7 , Y. Ohashi 8 , K. Watanabe 9 and K. Eguchi 10
1 Department of Thoracic Oncology, Kinki-chuo Chest Medical Center, Osaka,
JAPAN, 2 Department of Thoracic Oncology, Osaka Medical Center for Cancer
and Cardiovascular Diseases, Osaka, JAPAN, 3 Department of Internal Medicine,
Niigata Cancer Center Hospital, Niigata, JAPAN, 4 Department of Respiratory
Medicine, Gunma Prefectural Cancer Center, Ohta, JAPAN, 5 Center for
Respiratory Disease, Hokkaido Social Insurance Hospital, Sapporo, JAPAN,
6 Division of Integrated Oncology, Institute of Biomedical Research and Innovation
Hospital, Kobe, JAPAN, 7 Department of Respiratory Medicine, Kyorin University
Hospital, Tokyo, JAPAN, 8 Department of Biostatistics, School of Public Health,
The University of Tokyo, Tokyo, JAPAN, 9 Department of Respiratory Medicine,
Yokohama Municipal Citizen’s Hospital, Yokohama, JAPAN, 10 Internal Medicine,
Division of Medical Oncology, Teikyo University School of Medicine, Tokyo,
JAPAN
Background: Cancer cachexia, mainly characterized by muscle atrophy and
subsequent cancer induced weight loss (CIWL), is attributed to about a third of
cancer deaths. Despite worsening prognoses with the symptoms, clinical factors
involved and the effect of CIWL to the overall status remain unexplained. We
planned a prospective cohort study, Japan Nutrition and QOL survey in patients
with advanced NSCLC study to investigate changes in CIWL in relation to grip,
QOL, and clinical parameters to understand their effects on prognosis.
Method: Untreated stage IV NSCLC patients with ECOG PS of 0-2 were registered.
Their body weight (BW), grip, QOL, Karnofsky Performance Scale, biochemical
assay, and survival were recorded every four weeks for one year from the start of
cancer treatments. Patients were classified by BW loss ≥ 5% and cachexia diagnosis
by BW loss, fatigue, anorexia, and abnormal assay results. Estimated survival curves
were drawn by Kaplan-Meier method, and Log-rank test was applied. To evaluate the
effect of cancer cachexia attribution to QOL, we performed principal component
analysis, factor analysis, and analysis on time course data using generalized
estimating equation (GEE).
Results: Out of 466 patients registered, 406 were evaluable and analyzed. Patient
characteristics were: median age: 67 (33-87) years, male/female ratio: 280/126,
median BW: 56.5kg, PS 0: 39.2%, and PS 1: 51.5%. The patients with BW loss of ≥
5% (n = 219) reported more early deaths than those without (n = 166, p < 0.0001).
Patients with cachexia (n = 169) reported more early deaths than those without (n =
216, p < 0.0001). All correlations between principal component scores estimated from
the variables considered the signs of cancer cachexia (cancer cachexia attributions:
more weight on anorexia, fatigue, BW and grip) and each factor scores of QOL
domains estimated from QOL factor analyses were significant (p < 0.01). From the
time course data analyses using GEE, cancer cachexia attributions of each visit are
shown as useful variables for all QOL domains (p < 0.01).
Conclusion: Cancer cachexia decreased QOL and possibly affected prognoses.
Cachexia preventions and treatments based on the further elucidation of its
pathology are needed.
Disclosure: All authors have declared no conflicts of interest.
1587P SARCOPENIA AFFECTS TREATMENT TOXICITY IN
METASTATIC COLORECTAL CANCER PATIENTS: RESULTS
OF A PROSPECTIVE MULTICENTER STUDY
M. Barret 1 , C. Dalban 2 , J. Taieb 3 , D. Malka 4 , T. Mansourbakht 5 ,E.Latko 6 and
S. Antoun 7
1 Gastroenterology, Hopital Européen Georges Pompidou, Paris, FRANCE,
2 Department of Biostatistics and Epidemiology (ea4184), Centre Georges
François Leclerc, Dijon, FRANCE, 3 Gastroenterology and Digestive Oncology,
Hopital Européen Georges Pompidou, Paris, FRANCE, 4 Oncology, Institut
Gustave Roussy, Villejuif, FRANCE, 5 Gastroenterology, Hopital de la Pitié
Salpetriere, Paris, FRANCE, 6 Nutricia Advanced Nutrition, Danone, St Ouen,
FRANCE, 7 Emergency Department, Institut Gustave Roussy, Villejuif, FRANCE
Background: Malnutrition reduces tolerance to treatment, quality of life, and survival
in numerous cancers, including metastatic colorectal cancer (mCRC). Previous
Volume 23 | Supplement 9 | September 2012 doi:10.1093/annonc/mds416 | ix511